BEACON MEDICAL GROUP, INC. (NPI# 1932468352) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932468352 |
| Entity Type | Organization |
| Organization Name | BEACON MEDICAL GROUP, INC. |
| Other Organization Name | BEACON MEDICAL GROUP VASCULAR INTERVENTIONAL RADIOLOGY |
| Practice Address |
621 Memorial Dr Ste 312 South Bend IN 46601-1073 |
| Mailing Address |
710 N Niles Ave South Bend IN 46617-1924 |
| Practice Telephone | 5746475200 |
| Practice Fax Number | 5746475210 |
| Mailing Telephone | 5746471610 |
| Enumeration Date | 2012-05-04 |
| Last Update Date | 2017-10-12 |
| Authorized Official Name | JEFFREY P. COSTELLO (CFO) |
| Authorized Official Telephone | 5746473549 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 201063130A | 05 |
| Other Name | Type Code |
|---|---|
| Beacon Medical Group Vascular Interventional Radiology | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487038360 | Beacon Medical Group, Inc. | Radiology | 233 Florence Ave, Granger, IN 46530-8048 | 2015-07-10 |
| 1124423546 | Beacon Medical Group, Inc. | Internal Medicine | 100 Navarre Pl Ste 4400, South Bend, IN 46601-1100 | 2014-10-28 |
| 1487061131 | Beacon Medical Group, Inc. | Internal Medicine | 2400 N Ventura Way, Lagrange, IN 46761-4101 | 2014-07-15 |
| 1437574530 | Beacon Medical Group, Inc. | Otolaryngology | 711 S Health Pkwy Ste 1, Medical Office Building #1, Three Rivers, MI 49093-8354 | 2014-02-26 |
| 1528362647 | Beacon Medical Group, Inc. | Internal Medicine | 500 Arcade Ave., Suite 400, Elkhart, IN 46514 | 2011-01-04 |
| 1699794057 | Beacon Medical Group, Inc. | Internal Medicine | 500 Arcade Ave Ste 300, Elkhart, IN 46514-2486 | 2006-07-18 |
| 1205852365 | Beacon Medical Group, Inc. | Family Medicine | 27082 W. Main Street, Edwardsburg, MI 49112-9334 | 2006-07-14 |
| 1861421141 | Beacon Medical Group, Inc. | Psychiatry & Neurology | 100 Navarre Pl Ste 6600, South Bend, IN 46601 | 2006-06-30 |
| 1467408237 | Beacon Medical Group, Inc. | Pediatrics | 615 N Michigan St Fl 5, South Bend, IN 46601 | 2006-05-25 |
| 1275587149 | Beacon Medical Group, Inc. | Family Medicine | 813 S Michigan St, South Bend, IN 46601 | 2006-05-22 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | BEACON MEDICAL GROUP, INC. | 4601 Glendale Court, Savage, MN 55378-2543 |
| Street Address |
621 MEMORIAL DR STE 312 |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46601-1073 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801881255 | Howard Elvindo Wiarda | Radiology | 621 Memorial Dr Ste 312, South Bend, IN 46601 | 2005-09-13 |
| 1124671813 | Amanda Ann Aldana | Nurse Practitioner | 621 Memorial Dr Ste 312, South Bend, IN 46601-1073 | 2019-07-22 |
| 1376845073 | Stacy L Mc Dowell | Clinical Nurse Specialist | 621 Memorial Dr Ste 312, South Bend, IN 46601-1073 | 2010-12-01 |
| 1689669715 | Kevin M Small | Radiology | 621 Memorial Dr Ste 312, South Bend, IN 46601-1073 | 2005-09-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447610449 | David Thomas | Hearing Instrument Specialist | 808 S Michigan St., South Bend, IN 46601 | 2016-03-03 |
| 1285072454 | Kevin Francis Cumper | Internal Medicine | 621 Memorial Dr Ste 624, South Bend, IN 46601 | 2013-06-11 |
| 1952605560 | Robert Lusk Bonham | Dentist | 1222 L.w.e., So. Bend, IN 46601 | 2010-12-23 |
| 1649580911 | Daniel Scott Debrule | Psychologist | 211 W. Washington Street, Suite 2311, South Bend, IN 46601 | 2010-10-20 |
| 1528390770 | Luke Alfred White | Internal Medicine | 615 N. Michigan St., Memorial Hospital, C/o Erin Smith, South Bend, IN 46601 | 2010-02-12 |
| 1548497837 | Tmg Home Health Care | Home Health | 108 N Main St #305, South Bend, IN 46601 | 2009-06-15 |
| 1225283039 | Jody L. Hughes | Counselor | 202 S. Michigan Street, Suite 875, South Bend, IN 46601 | 2008-11-20 |
| 1740432574 | Amanda Jayne Quicksall | Social Worker | 611 Lincolnway W, South Bend, IN 46601 | 2008-10-10 |
| 1952565772 | Thomas P Judd | Dentist | 1901 #b Western Avenue, Ihc South Bend, South Bend, IN 46601 | 2008-07-10 |
| 1851590269 | Warren Larry Penrod | Nurse Practitioner | 333 W. Western Ave, South Bend, IN 46601 | 2007-07-16 |
| Find all providers in zip 46601 | ||||
| Taxonomy Code | 2085R0204X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Vascular & Interventional Radiology |
| A radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154856789 | Xrc Clinical Radiology, LLC | Radiology | 121 S Saint Louis Blvd, South Bend, IN 46617-2924 | 2017-04-20 |
| 1841434354 | Kelly Elizabeth Mortell | Radiology | 621 Memorial Dr, Ste 312, South Bend, IN 46601-1063 | 2009-04-28 |
| 1093893026 | Michael John Hall | Radiology | 621 Memorial Dr, Ste 312, South Bend, IN 46601-1063 | 2006-11-01 |
| 1689669715 | Kevin M Small | Radiology | 621 Memorial Dr Ste 312, South Bend, IN 46601-1073 | 2005-09-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306317565 | Donita Renee Morris | Radiology | 6910 N Oxford St, Indianapolis, IN 46220-2255 | 2018-12-16 |
| 1174099147 | Omnivas Nwi | Radiology | 8127 Merrillville Rd Ste 1, Merrillville, IN 46410-6306 | 2018-10-17 |
| 1669982492 | Us Access Care of Indianapolis, LLC | Radiology | 201 North Illinois St, 16th Floor - South Tower, Indianapolis, IN 46204-4618 | 2017-10-06 |
| 1487038360 | Beacon Medical Group, Inc. | Radiology | 233 Florence Ave, Granger, IN 46530-8048 | 2015-07-10 |
| 1396075982 | Ir Halum, LLC | Radiology | 5953 Calais Ct, Indianapolis, IN 46220-6004 | 2010-01-05 |
| 1952307480 | Joseph W Eke Jr. | Radiology | 711 S East St, Indianapolis, IN 46225-1317 | 2005-06-21 |
| 1053922849 | Ultrasonic Medical Specialists LLC | Radiology | 365 Conestoga Dr, Chesterton, IN 46304-1559 | 2020-08-13 |
| 1912522368 | Ng Medical Center LLC | Radiology | 5900 Hohman Ave, Hammond, IN 46320-2423 | 2020-06-11 |
| 1487176004 | Modern Vascular and Vein Center LLC | Radiology | 951 Transport Dr, Valparaiso, IN 46383-8434 | 2017-07-14 |
| 1952772782 | Nuvena Vein Center, LLC | Radiology | 3707 New Vision Dr, Fort Wayne, IN 46845-1702 | 2015-10-20 |
| Find all providers with the same taxonomy | ||||
| City | SOUTH BEND |
| Zip Code | 46601 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.